Graft Anastomotic Bleeding Detected With Transesophageal Echocardiography After Coronary Artery Bypass Grafting: A Case Report

Key Points

Transesophageal echocardiography effectively identified anastomotic bleeding in a 74-year-old woman.
Cardiac tamponade occurred 5 hours post-CABG surgery, revealing hemopericardial effusion via TEE.
The imaging technique demonstrated compression from pericardial hemorrhage related to the graft anastomosis.
Findings emphasize the importance of TEE in guiding surgical re-exploration after complications.

Abstract

Cardiac tamponade is a severe complication that occurs in 0.8% to 4.9% of cardiac surgeries and 0.2% of coronary artery bypass graft (CABG) surgeries. A 74-year-old woman developed cardiac tamponade 5 hours after on-pump arrested heart CABG. Transesophageal echocardiography (TEE) showed left atrial compression and ventricular diastolic collapse from pericardial hemorrhage. TEE revealed fresh hemopericardial effusion at the saphenous vein graft (SVG) and right posterior lateral branch (RPL) anastomosis, with small jets from the anastomosis site. TEE effectively identified anastomotic bleeding as the cause, aiding the surgical strategy during reexploration.

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